Talk to Patients About Alcohol Use, CDC Urges

Roughly 84% of U.S. adults have never discussed alcohol use with a healthcare professional, the CDC reported.

Among current drinkers, 17.4% reported ever discussing alcohol with a healthcare professional, and 25.4% of binge drinkers said they had done so, according to Lela McKnight-Eily, PhD, of the CDC's National Center for Chronic Disease Prevention and Health Promotion in Atlanta, and colleagues. In addition, 13.4% of binge drinkers said they had discussed their drinking behavior with a healthcare provider in the past year.

Healthcare professionals, nurses, social workers, and other counselors can conduct a brief screening and counseling of patients as a way to effectively intervene and potentially reduce a patient's drinking habits, said CDC Director Tom Frieden, MD, during a call with reporters Tuesday to discuss the Morbidity and Mortality Weekly Report data.

"The goal isn't to never have another drink, the goal is to lead patients down a path that causes the least harm," Frieden said.

The screening intervention consists of a four-step motivational interview that includes:

Asking a patient about their drinking

Speaking with them, in plain language, about what they think is good and not good about their drinking

Providing a patient with options, such as quitting drinking, cutting down, seeking help, or continuing current habits, and formulating a plan

Closing the discussion on good terms regardless of outcome

The agency listed primary care offices, emergency departments, obstetrics and gynecology clinics, and trauma centers as places where these screening steps should occur. Frieden emphasized that not all problem drinking behavior -- which he defined as 15 or more drinks a week for men and eight or more drinks a week for women -- indicated alcoholism, and that practices should build their own standard plan for screening patients.

In addition to practice-based screening, the Affordable Care Act requires new health insurance plans to cover screening for alcohol and brief counseling services without a copayment. Documents accompanying the CDC report also noted that the federal government is "working to enhance alcohol screening and counseling at federally qualified health centers" and "requiring states with expanded Medicaid to cover a set of preventive services, including alcohol misuse screening and counseling, through the Affordable Care Act."

Data for the report were collected through the Behavioral Risk Factor Surveillance System, a survey which included a question about patient-reported communication with a healthcare professional about alcohol. Data were recorded from 166,753 U.S. adults in 44 states and the District of Columbia.

The survey also found that roughly one-third of adults (34.9%) who reported binge drinking 10 or more times in the month prior to the survey had ever had a conversation about drinking with a healthcare professional.

"Excessive alcohol use is associated with increases in the chances of heart disease, breast cancer, sexually transmitted diseases, unintended pregnancy, fetal alcohol spectrum disorders, sudden infant death syndrome, motor-vehicle crashes, violence, suicide, and many other health problems," as well as an estimated $224 billion in economic costs in 2006, the authors noted.

They added that electronic screening and telephone, mobile, and Internet-based intervention options "have reduced peak consumption by 25% among binge drinkers in reviewed studies," and may serve as another route to deliver temperance to patients who overindulge in alcohol.

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